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Psychopathology Elliot Collins 12.06.16 Slide Credits: Kevin Jarbo and Prof Kody Manke What is mental illness? What constitutes addiction? Substance use disorders • • • • • • • • • • • Tolerance (need more to achieve the same effect) Withdrawal Substance taken in larger amounts, over longer time, than desired Persistent desire or unsuccessful attempts to cut down Significant energy spent obtaining, using, or recovering from substance Important social, occupational, or recreational activities reduced because of substance use Continued use in spite of knowing the problems that it causes Craving Recurrent use in physically dangerous situations Failure to fulfill major obligations at work, school, or home due to use Social or interpersonal conflicts related to substance use Number of Criteria Met over 1 year indicates severity: 2-3 (mild), 4-5 (moderate), 6-7 (severe) Outline • Mental health vs. Mental Illness • Diathesis-Stress Model • Assessment • Types of Disorders: • • • • • Anxiety Disorders Depressive Disorders Bipolar Disorders Substance Use Disorders Schizophrenia • Concluding Thoughts Risk of Mental Illness Is Widespread • Point prevalence • How many people live with a disorder at a given time • Lifetime prevalence • How many people will experience a given disorder at any point in life • Lifetime prevalence among US adults = 46% DSM-V Definition of Mental illness Outline • Mental health vs. Mental Illness • Diathesis-Stress Model • Assessment • Types of Disorders: • • • • • Anxiety Disorders Depressive Disorders Bipolar Disorders Substance Use Disorders Schizophrenia • Concluding Thoughts Modern Views: Diathesis-Stress Model • Diathesis • Predisposition (e.g., genetic) for disorder • Stress • Triggers disorder • Both diathesis (risk) and stress must be present for disorder Causes of Psychopathology: Genetic Risk • Some disorders like schizophrenia show a strong genetic component • (Graph) Individual’s Risk for Schizophrenia as function of type of relative with Schizophrenia From: Gottesman, I. I., & Erlenmeyer-Kimling, L. (2001). Causes of Psychopathology: Environmental Stressors • Many disorders show a strong influence of environmental stressors • (below) Mental Disorder Rates for Australian Korean War Veterans as function of Combat Exposure Australian DVA Executive Summary Causes of Psychopathology: Environmental Stressors • Many (but not all) combat exposed veterans develop psychopathologies such at PTSD • Why not all? Australian DVA Executive Summary Outline • Mental health vs. Mental Illness • Diathesis-Stress Model • Assessment • Types of Disorders: • • • • • Anxiety Disorders Depressive Disorders Bipolar Disorders Substance Use Disorders Schizophrenia • Concluding Thoughts Assessing Mental Disorders • Assessment is critical for understanding reasons for symptoms and developing a treatment plan • Diagnosis is important • Specific treatment • Disease specific resources • Insurance coverage • 2 primary methods of assessment • Clinical interviews • Self-report measures Assessment: Clinical Interviews • Semi-structured interview • Specific sequence of questions to identify certain diagnostic content • Symptoms • Patient report of physical or mental condition • Signs • Clinician’s observations of physical or mental condition Assessment: Self-Report Measures • Inventory of items to target symptoms or profile patients • Beck Depression Inventory • 21 items, specific to depression • Minnesota Multiphasic Personality Inventory (MMPI-2) • 567 items, broad profile of personality • Others • Montreal Cognitive Assessment (MoCA) • Mini-mental status exam (MMSE) Outline • Mental health vs. Mental Illness • Diathesis-Stress Model • Assessment • Types of Disorders: • • • • • Anxiety Disorders Depressive Disorders Bipolar Disorders Substance Use Disorders Schizophrenia • Concluding Thoughts Test your phobia knowledge Specific Phobia Acrophobia Arachibutyrophobia Androphobia Alliumphobia Automatonophobia Ablutophobia Agrizoophobia Amaxophobia Anglophobia 1 - 17 Fear of…. Specific Phobia Specific Phobia Fear of…. Acrophobia heights Arachibutyrophobia Peanut butter sticking to roof of mouth Androphobia men Alliumphobia garlic Automatonophobia Ventriloquist dummies Ablutophobia Washing or bathing Agrizoophobia Wild animals Amaxophobia Riding in a car Anglophobia England or English culture Want to know more? Try www.phobialist.com Panic Disorder • Recurrent panic attacks (requires attack plus 1 month of additional attacks or persistent concern about additional attacks) • • • • • • Palpitations Abdominal Distress Nausea Intense fear of dying or losing control, Light-headedness Chest pain, Choking, Chills, Sweating, Shaking, Shortness of Breath • PANICS • Physical manifestation of anxiety. Sympathetic overdrive Obsessive-Compulsive Disorder (OCD) • Obsessions: recurring intrusive thoughts, feelings, or sensations • Causing severe distress • Compulsions: repetitive action that relieves obsessions related distress. • Associated with overactive basal ganglia circuits https://www.youtube.com/watch?v=ufqFO5B1vQY Post Traumatic Stress Disorder (PTSD) • Triggered abruptly by identifiable, horrific event • Dissociation • “Numbness” to traumatic event • Reactions include intense, intrusive recurrent nightmares and flashbacks • Affects women and men equally, with different causes • Women: rape or assault • Men: combat-related Specific Differences in PTSD • Major clusters of symptoms persist >1 month • Re-experience • Nightmares, flashbacks • Arousal • Difficulty sleeping, concentrating • Avoidance • Avoid anything related to trauma • 7% lifetime prevalence • More likely in women Other Disorders of Anxiety • Body Dysmorphic Disorder • Anorexia Nervosa • Bulimia • Generalized Anxiety Disorder • Illness Anxiety Disorder (Hypochondriasis) Outline • Mental health vs. Mental Illness • Diathesis-Stress Model • Assessment • Types of Disorders: • • • • • Anxiety Disorders Depressive Disorders Bipolar Disorders Substance Use Disorders Schizophrenia • Concluding Thoughts What does DSM diagnosis criteria look like: Criteria For Major Depressive Episode A. At least five of the following symptoms have been present during the same 2-week period and represent a change from previous functioning: at least one of the symptoms is either 1) depressed mood or 2) loss of interest or pleasure. • • • • • • • • • • 1. Depressed mood most of the day, nearly every day, as indicated either by subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful) 2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated either by subjective account or observation made by others) 3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day 4. Insomnia or hypersomnia nearly every day 5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down) 6. Fatigue or loss of energy nearly every day 7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely selfreproach or guilt about being sick) 8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others) 9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or specific plan for committing suicide B. The symptoms do not meet criteria for a mixed episode. C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The symptoms are not due to the direct physiological effects of a substance (e.g. a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism). E. The symptoms are not better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation. Think Defn of mental illness, then simplify • 5 of below for at least 2 weeks (SIG E CAPS) • • • • • • • • • Sleep disburbance Loss of interest (anhedonia) Guilt or feelings of worthlessness Energy loss and fatigue Concentration problems Appetite/weight changes Psychomotor retardation or agitation Suicidal Ideations Depressed mood • Less pervasive variants of MDD include • Persistent depressive disorder (dysthymia) • Seasonal affective disorder Outline • Mental health vs. Mental Illness • Diathesis-Stress Model • Assessment • Types of Disorders: • • • • • Anxiety Disorders Depressive Disorders Bipolar Disorders Substance Use Disorders Schizophrenia • Concluding Thoughts Bipolar Disorder • Manic episode: persistent elevated, irritable mood, and high energy • • • • • • • • Diagnosis requires hospitalization or 3 of the following (DIG FAST) Distractibility Irresponsibility Grandiosity- inflated self-esteem Flight of ideas (racing thoughts) Increase in goal directed Activity/Psychomotor Activation Decrease need Sleep Talkativeness or pressured speech • Bipolar I: at least 1 manic episode w/ or w/o hypomanic or depressive episode • Bipolar II: hypomanic and depressive episode Outline • Mental health vs. Mental Illness • Diathesis-Stress Model • Assessment • Types of Disorders: • • • • • Anxiety Disorders Depressive Disorders Bipolar Disorders Substance Use Disorders Schizophrenia • Concluding Thoughts Schizophrenia • (most common) Psychotic Disorder • Psychosis: thoughts/emotions so impaired that individual losses touch with reality • Schizophrenia is not split/multiple personality disorder • Commonly diagnosed in adolescence or early adulthood; more often in men • Cognitive symptoms reflect impaired attention, working memory, inhibitory control, and even early sensory processing • Positive and Negative symptoms • Positive Symptoms: behaviors/thoughts that should not be present • Negative Symptoms: normal behaviors/thoughts that are missing Positive Symptoms of Schizophrenia -Not typically present in healthy individuals • Delusions • Systematized false beliefs of grandeur or persecution (delusions of reference) • Hallucinations • Sensory experience without actual external stimulation • Anderson Cooper tries a schizophrenia simulator • Disorganized behavior • Strangely dressed, violent or nonsensical behavior Negative Symptoms of Schizophrenia -Not typically absent or low in healthy individuals • Flat affect • Little to no display of emotion • Catatonic behavior • Anhedonia • No interest in pleasurable activities • Withdrawal • Isolation from social interactions • Development of idiosyncratic thoughts and behavior Schizophrenia: Example • https://www.youtube.com/watch?v=bWaFqw8XnpA Discussion How can we ameliorate the stigma associated with mental illness? What hurdles would such ideas face in their implementation? Concluding Remarks • Mental illness is ubiquitous • Mental illnesses exist at the extremes of normal behavior • Our social context can influence the illness stigmatization • We have no specific neural bases for many diagnoses in mental health. Behavioral diagnoses frequently overlap. How can we know what’s really going on with these patients.